It happened out of the blue, as such experiences often do.
I had parked my car and was walking a short distance from the public parking deck on a covered concrete sidewalk, past the open expanse of lawn and twinkling Christmas lights in front of the hospital. I was going to visit a friend who had just had surgery, and it had been quite some time since I had been in …
The memories we have during the holidays
The first thing we need to do is analyze what’s broken.
Let’s approach this problem as if it were a patient in our office. It’s our job to deliver a diagnosis based on the patient’s problem.
That’s easy; we’re doctors, after all.
“So, what seems to be the problem today, Mrs. Smith? How can I help you?”
“Well, it seems that no matter how hard I try, I can’t make progress. I want to …
What is it about today’s medical care system that isn’t working?
“You look nice today. People don’t come to chemo in suits very often.” The friendly and familiar receptionist mentioned as I was checking out, the always full jar of lemon flavored hard candy on the shelf between us. As I pocketed a few of the candies, I managed to swallow the nausea and metallic taste just enough to say, “Thanks. I have a job interview today.”
During my senior year in …
The sense of abandonment from my society
When I first started facilitating a grief support group shortly after moving to New York, my aim was simply to create a supportive environment for members to heal from their grief and to form long lasting bonds of friendship. In the course of five months however, I’ve begun to wonder whether emotional and psychological healing can be contained into an end goal with a finish line.
For the most part, authors …
After grieving and healing: Transformation
Before medical school I worked in a research lab investigating the relationship between stress and memory. As a research assistant, I dutifully administered memory test and collected saliva samples to test for cortisol levels.
My boss sent the data to her statistician for analysis, and was thrilled to find that despite the lack of connection between most of the variables of stress and memory studied, there was one positive finding — a …
Evidence-based medicine and the limitations of research
When you get frustrated with my interpreting a chest x-ray as “atelectasis at the right lung base, pneumonia can’t be excluded,” trust me, I don’t enjoy it. But when you ask me to rule out pneumonia you leave me no choice but to tell you that pneumonia can’t be ruled out.
To rule out a disease a test must have a sensitivity of 100%, meaning there should be no false negatives. …
Stop asking radiologists to rule out disease
Recently a colleague from IT who is working with us on our patient-centered medical home asked me, “when is the rollout date for your patient-centered medical home?”
As we have gone through this process for the past six months, I can definitely answer that there is no one day when this is going to happen. We are not going to close the door one night, turn out the lights, shut down …
Building the medical home requires incremental steps
Much has been made about the steady decrease in the number of U.S. medical school graduates choosing to pursue nephrology as a career. Even among nephrologists, both those in private practice as well as academia, there has been substantial hand-wringing on this issue.
My more pessimistic colleagues see a subspecialty in decline, which they attribute to a myriad of factors. These include the encroachment on our “turf” by other sub-specialists (intensivists …
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
When you need anesthesia for surgery or a diagnostic procedure, of course you want to know who’ll be giving you anesthesia. If you live in Texas, Florida, the District of Columbia, or 14 other states, you may be lucky enough to have an anesthesia team taking …
Anesthesiologist assistants should be able to practice in every state
As a pain physician, I would like to personally explain to President Barack Obama, Kathleen Sebelius, senior citizens and any disabled American suffering in pain, the devastating effects that will result from the drastic Medicare cuts in chronic pain care that are scheduled to take effect January 1, 2014. These cuts will severely, drastically and unfairly cut access to chronic pain care for senior citizens and other Medicare beneficiaries and …
Stop the Medicare cuts to senior citizens and the disabled in pain
Let me concede from the outset that I lean toward the negative — dire predictions, worst-case scenarios, a bit of doom and gloom, etc.
But I ask you, oh gentle, patient reader, how could I not?
Let’s go to the satellite. You can see warm air from a low-pressure system (meaningful use stage 2, not changed dramatically by the one-year extension) collide with cool, dry air from a high-pressure area (the turmoil …
ICD-10 will lead to the perfect storm in health care
First a disclaimer: I’m a psychiatrist, not a cardiologist, but I’ve followed with personal interest the discussions about calculating cardiac risk and indications for statin treatment. Risk is an interesting word, because risk is about populations; it loses the individual.
And it seems that statin treatment has taken on a bit of stigma — something we’re used to in psychiatry — now you can eat your cake and have low cholesterol, …
Another take on the statin issue: Can lifestyle changes kill?
If you learn nothing else today, I would ask you to learn that moral hazard is the cause of medical price hyperinflation.
Moral hazard is not just two words that don’t seem to go together. Moral hazard is when the person who bears the economic burden of a decision is not the decision maker. In the health care setting, moral hazard is when the third party payer (insurance/government) bears the …
The cheapest form of health care is to let sick people die
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In a scene from the 1999 cult classic “Office Space,” three burned-out cubicle drones take a baseball bat to a malfunctioning printer. While I do not condone violence against innocent peripheral hardware, I admit I secretly fantasize about destroying medical center fax machines.
Recently, a chronically non-compliant end stage kidney disease patient on dialysis was admitted for minimally elevated troponins and non-ST segment EKG changes in the setting of a hypertensive …
Fax machines represent medical waste, error, and expense
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 70-year-old man is evaluated for a 3-month history of night sweats, weight loss, and increasing cough. He is a retired miner, and his medical history is significant for a diagnosis of pulmonary silicosis made 15 years ago based on exposure history and characteristic chest radiographic findings. He is a lifelong nonsmoker.
On …
MKSAP: 70-year-old man with night sweats, weight loss, and cough
On a recent cross-country flight, I feigned sleep and overheard the following conversation between my seatmates: a radiation oncologist (I’ll call her “Dr. M”), and a former firefighter/paramedic called, “Captain.” Thought you’d like to listen in.
DR. M: You guys have been my heroes for a long time, the way you constantly put your lives on the line.
CAPTAIN: We’re in serious danger 10% of the time, at most. Moderate danger another …
Will the real hero please stand up?
Whenever a discussion of health care policy is initiated, the importance of health insurance, of extending coverage, takes center stage. The need for insurance quickly becomes an undeniable truth, a universal imperative. And we never seem to question this premise enough before getting more patients fitted with shiny, new policies. This was precisely the case with the Affordable Care Act. But where is the evidence insurance plays any role in …
The Affordable Care Act perpetuates a myth of health insurance
I’ve been chronically ill since I contracted a viral infection in 2001. Were I to recover, I’d take these six hard-earned lessons with me into the land of the healthy.
1. Less is more. I used to be an accumulator. My life was filled with stuff: books and magazines that sat unread; CDs; jewelry; knickknacks and trinkets; clothing and all its accompaniments (shoes, belts, scarves). Since becoming sick, I’ve learned that less …
6 lessons the sick can teach the healthy
Les called me about his PSA.
“Jim, it’s rising and now up to eleven and they’re recommending treatment. What would you do?”
Even as a long retired MD, I still get medical calls from friends and relatives. Actually, I feel honored and try to do my best, researching the latest journal articles and editorial opinions. Of course, the prostate cancer literature is cloudy at best with scant evidence that the huge number …
Hospice stays remain far too short
I rather doubt you need me to bring the roiling statin debate to your attention, given its prominence in scientific circles and mass media alike. In essence, a new set of guidelines for the use of lipid-lowering drugs to prevent heart disease was issued with considerable fanfare and then set off a firestorm of controversy. The old approach relied heavily on levels of LDL cholesterol, while the new …
The statin debate ignores the signal of lifestyle as medicine
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